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Wound Care Warrior

A consummate nurse, Patrice Dillow, MSN, RN, CWOCN, refuses to take credit for Cancer Treatment Centers of America's (CTCA's) near elimination of hospital-acquired pressure ulcers, but her drive to educate colleagues about the latest evidence-based practices was a huge contributor.

Around the same time as Dillow started as a nurse consultant-in 1997-the National Database of Nursing Quality Indicators (NDNQI) conducted a survey that found an increase in Hospital-Associated Pressure Ulcers (HAPU), which are caused by lack of movement and body pressure that cuts off the blood supply to parts of the body. Pressure ulcers effect 15 percent of elderly patients within the first week of hospitalization and have numerous affects on patient care, including an increase in patient length of stay and delay in cancer treatment.

The National Pressure Ulcer Advisory Panel (NPUAP) released its staging system and distinguished deep tissue injuries (DTIs) as frequently misclassified Stage I pressure ulcers. To raise awareness, NPUAP arranged a series of presentations to inform wound care providers of the clinical complications with DTIs.

As the go-to person in her facility for purple heels, Dillow enthusiastically traveled to the lecture hall to hear the latest official updates and bring marching orders back to her fellow nurses at CTCA.

"We always knew what DTIs were but it was so exciting to finally have a science behind the concept," she said. "We'd been teaching about the 'iceberg effect' for a long time but this gave it a name."

Lifelong Learning

The national momentum to identify DTIs before they turned into pressure ulcers captured Dillow's passion and her enthusiasm was catching on within CTCA.

A Six Sigma Green Belt, Dillow prompted the facility to offer skin assessment training to all nurses, saved pressure ulcer policies in handy spots on hospital computers and developed patient education materials. It's been an almost 20-year project in the making, as the verbiage changes frequently in the literature.

"We always want our patients to get the best preventive care," she said. "Every CTCA nurse or technician went through wound ostomy classes again."

The education portion takes on a critical importance in a cancer center, said Dillow.

"If the patient has bone pain, we can't reposition," she noted. "For those situations, we brought in a one-person shear sheet. In the ICU, we integrated the wound care best practices with a no-lift turn system. Since patients with cancer have so much going on, we just have to tweak a little more."

Clinical practice guidelines were reviewed frequently, as when the language changed or when a new electronic medical record was implemented. Yearly competencies are required but Dillow said the staff takes great pride in personalizing their care. For example, fellow nurses in the OR coined the 2-person "look and see" system of assessing skin between OR and recovery.

"Every employee here is hands-on with the patient," Dillow stated. "Our nurses, dieticians, radiation techs, and administrators know the role of nutrition and transport in preventing pressure ulcers."

CTCA's quarterly pressure ulcer standing of 0 for six successive quarters, down from 4.67 in the 4th quarter of 2010 is testimony that the staff is committed to eliminating HAPUs. It was enough to earn Dillow a DAISY award for her education and compliance effort.

"I couldn't have achieved this without a dedicated team and administrative support," Dillow said. "Besides having passion every single day, I'd advise nurse leaders to continually stay current with teaching on evidence-based practices."